23 July 2009

With the admission that the Senate is for sure going to miss the August deadline for a vote on health insurance reform, it's looking certain that any final action on reform is going to last into October or possibly November. Which is a pity, because it means there will be that many more days in which I will have to knock down the misinformation, confusion, and deliberate mendacity of those who are opposed to reform. The reigning champion, by the way, is Betsy McCaughey, (the lady on the right with the SCARY TEETH) who seems to make her living by lying about health care. Seriously, she has got to be the least credible voice out there, which is why the WSJ op-ed page keeps going back to her every time they want to spread FUD. (Note to her publicists: you can stop sending me press releases every time she publishes something new. I'm on the other team.)

So, just for the record, here's the fisking of her latest hackery, published today:

H.R. 3200 and the Senate Health Committee Bill—will reduce access to care, pressure the elderly to end their lives prematurely, and doom baby boomers to painful later years.

Yes. In fact, the original name of the bill was the "Make Old People eat Cat Food Act of 2009," but they didn't like the acronym. Moving on:

The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare.

"Cut." Nice. We call it savings, but "cuts" sound scarier, don't they? Which is funny because isn't a common criticism of Medicare that it's too expensive/bankrupt/inefficient? Which is it? Should we cut find savings in Medicare, or should we protect it at all costs?

The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient’s age.

Really? Damn, my decrypter must be broken, because I thought CER meant finding which treatments were most effective so doctors could make the best choices in providing efficient, effective care to patients.

In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than younger patients.

Every single ER doc I know despairs when we see the 90-year-old demented nursing home patient come in septic and in multi-organ system failure with family members insisting that "everything" be done. Some people are unable to admit when care is futile, and nobody wants to be the bad guy and say "no more," when families (or patients) are requesting inappropriate care. Betsy McCaughey apparently believes that we never will need to confront these hard choices, or that when we do, we are better served not knowing what the best options are.

White House budget chief Peter Orszag urged Congress to delegate its authority over Medicare to a newly created body within the executive branch. This measure is designed to circumvent the democratic process and avoid accountability to the public for cuts in benefits.

You hear that? Peter Orszag is the bureaucrat standing between you and your doctor! Damn. I had Kathleen Sebelius in the office pool.

Oh, and by the way, primary care doctors SUCK ASS:

The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process. In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner.

See, those silly liberals think that uninsured people need family doctors! It turns out all we needed were more electrophysiologists! And oculoplastic surgeons. And endoscopic urologists. etc, etc, etc. No disrespect to the specialists, but this is just insulting to PCPs. And it's straight out of Bizarro World to suggest that primary care is not in need of more support. This line of argument alone should disqualify Ms McCaughey from ever being taken seriously as a health policy commentator.

While the House bill being pushed by the president reduces access to such cures and specialists, it ensures that seniors are counseled on end-of-life options, including refusing nutrition where state law allows it. In Oregon, some cancer patients are being denied care by the state that could extend their lives and instead are afforded the benefit of physician-assisted suicide instead.

This paragraph is simply a work of art. Nowhere is there any supporting evidence for the claim that access is reduced -- I assume it's implied in the emphasis on primary care? But it's beautifully linked to the implication that OBAMA is going PERSONALLY SMOTHER YOUR GRANDMOTHER WITH HER HOSPITAL PILLOW. Actually, it's worse; he's going to stand there and smoke a cigarette while he FORCES HER TO SMOTHER HERSELF.

The harshest misconception underlying the legislation is that living longer burdens society. Medicare data prove this is untrue. A patient who dies at 67 spends three times as much on health care at the end of life as a patient who lives to 90.

Hmm. Possibly. Of course the medicare data ususally looks at the "last three years" of life. So that hypothetical 90-year-old who has the courtesy to die on the cheap, unfortunately, lived an extra 20 years longer and probably consumed a lot of medical care during that time. (This is, by the way, the reason Obama wants to smother your grandmother - to save money.)

This article really is a classic. It distorts the actual facts of the health care proposals, flat out makes up shit about primary care, scares the living bejeezus out of baby boomers gullible enough to think the WSJ Op-Ed page is as credible as the rest of the WSJ, and finishes with a modest propsal to fix everything by (wait for it) reducing access by increasing the eligibility age!

Ms McCaughey's opposition to Comparative Effectiveness Research, by the way, should in no way be assumed to be related to the fact that she is a current and former board member and still being compensated by medical device makers who stand to lose millions of dollars if their pricey devices were judged to be less effective than less-expensive therapies. No way, sirree. Nothing to see here, now move along....

5 comments:

Love the zeal, man, but I'm not sure that the ad hominem approach - no matter how varied and lively - is going to be sufficient to move this social-consensus/legislation forward.

It's not that there aren't people who oppose these reforms out of greed, heartlessness, or any variety of unsavory motives - I'm sure that there are - and shame on them. Even if we postulated a single moral frame of reference where we could objectively classify particular motives as either good or bad, it wouldn't necessarily follow that every piece of legislation favored by folks with the purest and most noble sentiments imaginable would have beneficial effects on society, or that those championed by actors with bad motives would be detrimental. One could cite innumerable man-made misfortunes, tragedies, and outrages in the historical record that had their genesis in good intentions, but - it's hardly necessary to venture that far afield.

Take the RBRVS. Let's take it as granted that the Harvard actuary who developed the cost-of-inputs model for price this variant on price controls, and all of the folks who supported its passage into law - were inspired by the best of intentions. Did the character of their motives automatically translate into better care for patients, or a superior allocation of finite medical resources?

I suspect that there are quite a number of primary physicians who have had their status, compensation, and working conditions systematically downgraded relative to specialists under the RBRVS that might question the extent to which good intentions have translated into equally good outcomes in this particular case. Ditto for all of the patients who face the prospect of an increasingly acute shortage of PCP's as both practicing physicians and residents respond to the incentive structure which the RBRVS generated.

The fact not only is it far from clear that good-intentions = good outcomes would be sufficient to call the ad hominem strategy into question. The fact that that there *are* people out there who are both well intentioned and well informed who oppose specific elements of the reforms that you favor makes the tactic even less likely to succeed. That is, if your goal is to convince people who disagree with you to or to help - in some very small way - to advance a specific legislative agenda. If neither of those ends has anything to do with what inspires you to contribute these posts to your blog - nevermind.

Having said that, you are clearly intelligent, informed,and passionate - so a post or two where you focus on a specific provision that you'd like to see implemented, muster all of the factual and logical gusto at your disposal to make the case for it, and invite people to challenge either your facts or reasoning would be a welcome contribution to the larger debate that the country is engaged in at the moment.

Thanks for the thoughtful response, but, excuse me for asking, are you new around here?

"a post or two where you focus on a specific provision that you'd like to see implemented, muster all of the factual and logical gusto at your disposal to make the case for it, and invite people to challenge either your facts or reasoning would be a welcome contribution to the larger debate that the country is engaged in at the moment."

There must be forty posts about specific policies in the last three months alone. Like this, or this one, or this one. Now you may say that I'm reporting, not persuading, and that may be a fair point. You'll find more boring policy discussion on this blog than inflammatory attacks on party hacks -- this post being an exception, because the McCaughey piece is such a glaring piece of dishonesty.

you've gone off the deep end unfortunately. i consider myself moderate and the tone of your recent posts is distasteful. the term cuts is a reasonable one for those who have a different viewpoint than yours. as is their disagreement that more specialists will be needed in the future. there is plenty of data that supports their position that cardiologists provide better follow up care (complaint to guidelines at least) for heart failure patients than primary care doctors. do they state we don't need more primary care doctors? i don't think so. it is just a question of how to finance more primary care doctors while retaining desirable services.

it is fine if you don't want to encourage reasonable discussion on your blog, but certainly the tactics you despise are used by both sides in good measure.

"Cuts" would indeed be a reasonable, if debatable, term were it not conjoined with the dishonest scaremongering in the rest of the article. I have to give credit, her distortions are skillful and subtle. That's what makes this sort of thing hard to counter: a changed word here, a shaded meaning there is extrapolated drastically in its "logical extension," just as the "cuts" translated to "reduced access" in this article, an argument which is not supported by any facts I am aware of.

Yes - I'm new here. I appreciate the links, and will read theme when I get a moment, but the "people who disagree with me are all unsavory characters who are acting in bad faith" theme seemed pretty consistent during my initial scrollage, and I didn't encounter an increasing tendency towards a more nuanced "they're not evil, just wrong" posture as I scrolled downwards. Ergo - I assumed that the "they're evil, and wrong" tendency would persist no far how back I looked.

Would we both agree that this debate isn't best settled by appeals to superior personal virtue? Both of us would probably rank considerably lower than Mother Teresa in a public opinion survey. Does this make the evidence and analysis that we marshal on behalf of our arguments less compelling than hers?

Her motives, my motives, your motives - all fall into the "interesting, but irrelevant" category when it comes to determining the best means of efficiently coordinating the supply of medical care, drugs, and devices with demand in this country.

(When I have the time)I am prepared to argue that removing third party rationing mechanisms from as many medical decisions as possible in a system that combines individual deductability, tax-sheltered HSAs, high-deductable catastrophic insurance, income-indexed vouchers and subsidies, more competition, price transparency, and a few minor tweaks to the rules will reduce costs, increase access, and improve efficiency far more than the model that you seem to favor.

If it helps - assume that I am, literally, Satan Incarnate and that the inspiration for the model that I favor has its genesis in the fact that I am hell bent on inflicting as much misery on humanity as the twisted machinations of my dark heart will permit. Having said that, please refrain from reflecting on my moral status when arguing on behalf of your own policy preferences vis-a-vis my own. Or at least confine them to footnotes.

Not sure that I'll need to ID myself given my congenital logorrhea (waiting to see my PCP so that I can get referred to a specialist for that), but I'll sign out as "Satan" from now on just in case.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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